Have you completed the Free Application for Federal Student Aid (FAFSA) or the online Renewal Application?

If yes, when did you submit it?

List below any outside scholarships, grants, bursaries, loans or other assistance (including dollar amounts) that you expect to receive for the 2015-16 school year. It is not necessary to list any aid from Dordt College; only outside sources:

Did you have a job on campus last year?

If yes, please list:

Section B: Parents' Information—For all DEPENDENT students

Father/Stepfather:

Occupation:

Employer:

Mother/Stepmother:

Occupation:

Employer:

Did either parent attend Dordt for one full year or more and successfully complete at least 24 credits?

If yes, who?

Give information for all dependent children and other dependents for 2015-16 (those included in the FAFSA):

Name and Relationship (e.g. brother, sister)

Age

Name of school or college this person will attend in 2015-16 school year

Year in school 2015-16

If attended college in 2014-15, give amount of:

2014-15 Scholarships or Grants

2014-15 Parents' Contribution

*If more than 6 dependents, list additional family members under Other Special Circumstances.

Will either parent be attending college at least half-time in 2015-16?

If yes, please list name, city, and state of college:

Divorced/Separated Parents (completed by the parent who files this form):

Is there an agreement specifying a contribution for the student's education?

If yes, how much per year? $

Parents' Assets:

Do parents own a home?

Value of home today: $

Debt on home today: $

Do parents own a farm?

Value of farm today: $

Debt on farm today: $

Include a family farm which is your principal place of residence and source of revenue. Such farms are NOT to be reported on the FAFSA #89.

Do parents own a small business?

Value of business today: $

Debt of business today: $

Include a small family business which you own and control and that has 100 or fewer employees. Such businesses are NOT to be reported on the FAFSA #89.

Parents' 2015 Expected Income:

2015 income earned from work by father: $

2015 income earned from work by mother: $

Section C: Request for Consideration of Special Circumstances

When this form is processed, formulas will be applied which assess how much the parents can contribute and how much the student can contribute. This effective family contribution will be based on parents' and student's income and assets with standard allowances made for other necessary expenses.

Sometimes families have special circumstances which substantially affect their ability to contribute towards educational expenses. Two of the most common special circumstances at Dordt College are tuition paid for other family members at elementary or high schools, and excessive medical/dental expenses. Occasionally other factors may affect the family's contribution, such as: a significant reduction in parental income for the upcoming year, other non-discretionary expenses not mentioned on the form, a higher cost of living than the national average, a significant debt not reported on the form, or a natural disaster. (Special circumstances refer to something unique to your family.)

If you would like to request consideration for special circumstances, please complete the appropriate items below.

Tuition for other children. Indicate the total tuition paid in 2014-15 for children in kindergarten through grade 12: $

Medical/dental expenses not covered by insurance. An allowance will be considered for medical/dental expenses paid in 2014 if, including insurance premiums, they exceed 7.5% of income (Form 1040, Schedule A, line 1): $

Other Special Circumstances--please itemize giving specific dollar amounts and explain in paragraph form any unusual situations:

By completing the box/boxes below and submitting this form I/we certify that all information is correct and complete: